Temple University of the Commonwealth System of Higher Education

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Doing business as

Temple Gastroenterology

Practice address

3401 N Broad St
Philadelphia, PA 19140-5103

Phone

(215) 707-9900

Fax

(215) 707-3831

NPI assigned

Oct 13, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Tonya M Woodard

Title

Credentialing/Manager

Phone

(215) 707-3911

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Temple Gastroenterology Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529020800000",
    "number": "1093703910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-9900",
            "fax_number": "215-707-3831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-9900",
            "fax_number": "215-707-3831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 S 17th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191036231",
            "country_code": "US",
            "telephone_number": "215-707-9900",
            "fax_number": "215-707-3831",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Washington",
            "state": "PA",
            "postal_code": "190343314",
            "country_code": "US",
            "telephone_number": "215-707-9900",
            "fax_number": "215-707-3831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2018-06-15",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING/MANAGER",
        "authorized_official_telephone_number": "215-707-3911",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130061",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130724",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130732",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Gastroenterology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Temple Gastroenterology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Temple University of the Commonwealth System of Higher Education (Temple Neurology Associates)
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• Temple University of the Commonwealth System of Higher Education (Temple Pain Management)
• Temple University of the Commonwealth System of Higher Education (Temple Cardiology)
• Temple University of the Commonwealth System of Higher Education (Temple Neurosurgical)
• Temple University of the Commonwealth System of Higher Education (Ophthalmology Associates PPP)
• Temple University of the Commonwealth System of Higher Education (Temple Critical Care Peds Tucmc)
• Temple University of the Commonwealth System of Higher Education (Temple Pulmonary Critical Care)

• Gastroenterology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Gastroenterology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.